=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861279366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSON WAGNER BROWN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2023
-----------------------------------------------------
Last Update Date | 09/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 297 STONER AVE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-5629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-289-3790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3385 JEFFREY LORI SOUTH DR
-----------------------------------------------------
City | FINKSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21048-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-404-2492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 19707
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------